Invitation - Free Spirit · 2011. 7. 1. · Invitation Dear Colleagues, It is with great pleasure that we invite you to join us to the 1st Annual Joint Conference of the Hellenic

Invitation

Dear Colleagues,

It is with great pleasure that we invite you to join us to the 1st Annual Joint Conference of

the Hellenic Association for the Study of Diabetic Foot Diseases (EMEDIP) and the

Multidisciplinary European Endovascular Therapy (MEET). The Meeting will be held in Porto

Heli, Peloponnese, Greece, 7-10 July 2011.

This meeting is unique in the way it brings together specialists involved in the care of

persons with diabetes, suffering from Diabetic Foot Diseases. This fact creates an

environment in which all the aspects and hot topics in the above mentioned field will be

presented and analyzed by the eminent speakers.

Since atherosclerotic peripheral vascular disease with the infection is a major factor in the

pathology and progression of diabetic foot, special sessions will focus on the diagnosis and

treatment of Foot Ischemia of both infected and non infected leg. Apart from the numerous

plenary lectures, other review sessions and interactive workshops from renowned scientists

have been integrated in the programme and will cover all of the other aspects, from the

epidemiology and burden of diabetic foot related problems, to the treatment and

rehabilitation.

The vivid exchange of knowledge of all the specialities involved and participating in this

Meeting, introducing the concept of the multidisciplinary team approach to the diabetic foot

care, will be further established by the discussion of the current status of clinical and basic

research, presented orally or in the form of posters by the attendees.

We hope that we will have the opportunity to welcoming you at the excellent seaside resort

of Porto-Heli, for the 1st Annual Joint Conference of our Associations and enjoy with you an

excellent scientific event.

For the Organizing Committee

Chr. Manes P. Bergeron D. Raithel

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Organizing Committee

CHAIR: C. MANES

CO-CHAIRS: P. BERGERON

D. RAITHEL

MEMBERS: K. KALLIGIANNI

A. KAMARATOS

T. KATSAROS

T. MESIMERIS

A. PAPPAS

N. TENTOLOURIS

Scientific Committee

V. ANDRIKOPOULOS

I. APOSTOLAKIS

P. BALAS

A. BOULTON

E. DEMIRI

E. DIAKOUMOPOULOU

A. DIAMANDOPOULOS

A. DIONYSSOPOULOS

L. INGLESE

S. KALLIAFAS

N.L. KATSILAMBROS

D. KISKINIS

A. KOKKINOS

K. KTENIDIS

C. LIAPIS

S. LIATTIS

K. MAKRILAKIS

G. PARHARIDIS

D. PERREA

S.A. RAPTIS

ScientificProgramme

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Scientific ProgrammeDAY 1

Thursday 7 July, 2011

G R A N D B A L L R O O M I I & I I I

16:00-17:00 Registrations

17:00-18:00 Workshop I:Off loading - dressings

Chair: C. Loupa

Speakers: Μ. Valsami, L. Thiaspras

18:00-18:30 Round Table: Epidemiology, pathogenesis and consequences of the diabetic foot

Chair: P. Balas

18:00-18:10 Epidemiology of the diabetic foot: C. Manes

18:10-18:20 Pathogenesis - socio - economic consequences: Ν. Tentolouris

18:20-18:30 Discussion

18:30-19:00 Lecture

Chair: C. Manes

The history of crutch through the art: Ε. Dounis

19:00-19:45 Coffee Break

19:45-20:30 Welcome Addresses

20:30-21:00 Keynote Lecture

Chair: S.A. Raptis

Mediterranean diet and health: N.L. Katsilambros

21:00 Welcome Reception

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DAY 2

Friday 8 July, 2011


09:00-10:00 Workshop II: Differential diagnosis of ulcers - case reports and open discussion

Chair: C. Manes

Speaker: T. Katsaros

10:00-11:15 Round Table: Diabetic cardiovascular disease - multifactorial approach

Chairs: V.N. Pyrgakis, C. Rokkas

10:00-10:15 Dyslipidaemia: Κ. Makrilakis

10:15-10:30 Cardiac disease and diabetes: V.N. Pyrgakis

10:30-10:45 Surgical treatment of coronary artery disease in diabetic patients: C. Rokkas

10:45-11:00 Diabetes and thoracic aortic aneurysms: update on endovascular and hybrid solutions: D. Raithel



11:45-13:15 Round Table:Infections

Chairs: A. Giannopoulos, G. Petrikkos

11:45-12:05 Diagnosis - conventional treatment: D. Plachouras

12:05-12:25 Radiologic imaging: A. Bintoudi

12:25-12:45 Surgical treatment of soft tissue infections: D. Dimitroulis

12:45-13:05 Surgical treatment of bone infections: F. Sayegh


13:15-14:00 Satellite Lecture (BMS/AstraZeneca)

Chair: N. Tentolouris

The impact of DDP-4 inhibitors in type 2 diabetes treatment in Greece: K. Makrilakis

14:00-14:30 Satellite Lecture (Roche Diagnostics Hellas S.A.)

Chair: C. Manes

Technology at the service of Diabetes Mellitus: Ν. Τentolouris

14:30-16:15 Break

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16:15-17:30 Round Table:Management of the diabetic patient in the hospital

Chairs: Ν.L. Katsilambros, C. Manes

16:15-16:35 Perioperative management: Α. Thanopoulou

16:35-16:55 The patient in the coronary care unit: A. Kokkinos

16:55-17:15 The patient in the intensive care unit: C. Adamopoulos



17:45-19:00 Satellite Symposium (Pharmaserve Lilly)Aggressive therapeutic treatment when oral antidiabeticscombinations fail

Chair: Ε. Hatziagelaki

17:45-18:15 Impact of incretin mimetic based therapy on diabetic vascular disease: Μ. Theodorakis

18:15-18:45 Εffectiveness of analogues’ mixes in patients who need insulin therapy: Ε. Hatziagelaki


19:00-19:15 Welcoming from the President and overview of the diabetic arterialdiseaseC. Manes

19:15-21:00 Round Table:Diabetic foot patient - multifocal diabetic disease

Chairs: P. Balas, L. Inglese, Ι. Tsitouridis

19:15-19:30 Diabetic foot and coronary artery disease

How should we manage such a patient?: S. Polymeros

When to intervene: timing and strategies: C. Rokkas

19:30-19:45 Diabetic foot and cerebrovascular disease

How should we manage such a patient?: D. Raithel

When to intervene: timing and strategies: K. Kalligianni

19:45-20:00 Diabetic foot and renal disease

How should we manage such a patient?: A. Diamandopoulos

When to intervene: timing and strategies: A. Giannoukas

20:00-20:15 Diabetic foot and aortic disease

How should we manage such a patient: D. Kiskinis

When should we operate such a patient?: P. Bergeron

20:15-20:30 Indications of operative treatment of arterial disease in the diabetic patient: C. Liapis


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G R A N D B A L L R O O M I

09:00-11:00 Oral Presentations

Chairs: Α. Kokkinos, E. Papazoglou

OP1 MICROVASCULAR COMPLICATIONS AND RISK FACTORS, COEXISTENCE,

THEIR ROLE IN THE PATHOGENESIS AND THE SEVERITY OF DIABETIC

FOOT

D. Skoutas, N. Papanas, Z. Mousleh, S. Giandikidis, G. Tsiantas, S. Georga,

Th. Mesimeris, N. Papazoglou, M. Lazaridis, Ch. Manes

OP2 PREVENTION AND MANAGEMENT OF THE DIABETIC FOOT - OUR

EXPERIENCE FROM OUR NEW DIABETIC FOOT CLINIC

Bristianou M., Panou Ch., Chatzidakis I., Tsiligrou V., Mytis G., Lanaras L.

OP3 OSTEOPROTEGERIN LEVELS CORRELATE WITH SEVERITY

OF PERIPHERAL ARTERIAL DISEASE AND PERIPHERAL NEUROPATHY

IN TYPE 2 DIABETIC PATIENTS

Eleftheriadou Ioanna, Grigoropoulou Pinelopi, Argiana Vasiliki, Balla Ioanna,

Chorepsima Stamatina, Kokkinos Alexander, Perrea Despoina,

Katsilambros Nicholas, Tentolouris Nicholas

OP4 SERUM OSTEOPROTEGERIN LEVELS CORRELATE WITH SEVERITY OF

LOWER EXTREMITY ARTERIAL CALCIFICATION IN PATIENTS WITH TYPE

2 DIABETES

Eleftheriadou Ioanna, Argiana Vasiliki, Grigoropoulou Pinelopi, Balla Ioanna,

Kritikos Constantinos, Arapostathi Christina, Kokkinos Alexander,

Perrea Despoina, Katsilambros Nicholas, Tentolouris Nicholas

OP5 POPLITEAL ARTERY PERCUTANEOUS TRANLUMINAL ANGIOPLASTY

FOR CHRONIC CRITICAL LIMB ISCHEMIA AND DIABETES MELLITUS

LESIONS. ANALYSIS OF A SINGLE-CENTER EXPERIENCE

Argitis V., Kyriakidis K.,Tabakis H, Dervisis K.

OP6 PLEIOTROPIC EFFECTS OF ATORVASTATIN ON CENTRAL AND

PERIPHERAL ARTERIES OF PATIENTS WITH TYPE 2 DIABETES

P. Grigoropoulou, I. Eleftheriadou, C. Zoupas, V. Argianna, A. Kokkinos,

D. Perrea, N. Katsilambros, N. Tentolouris

OP7 BULLOSIS DIABETICORUM: A NOT-SO-RARE CONDITION

CHARACTERISTIC OF DIABETES MELLITUS

C. Loupa, E. Voyatzoglou, A. Donou, N. Souliotis, E. Meimeti, D. Voyatzoglou†

OP8 THE ASSOCIATION BETWEEN DIABETIC AUTONOMIC NEUROPATHY

AND CUTANEOUS CIRCULATION IN PATIENTS WITH TYPE 2 DIABETES

Eleftheriadou Ioanna, Grigoropoulou Pinelopi, Argiana Vasiliki, Fardi Panagiota,

Kalopita Stavroula, Alexiadou Kleopatra, Kokkinos Alexander, Perrea Despoina,

Katsilambros Nicholas, Tentolouris Nicholas

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OP9 ASSOCIATION OF ARTERIAL STIFFNESS AND CARDIOVASCULAL RISK

FACTORS IN PATIENTS WITH TYPE 2 DIABETES

P. Grigoropoulou, I. Eleftheriadou, C. Zoupas, V. Argianna, I. Balla, A. Kokkinos

D. Perrea, N. Katsilambros, N. Tentolouris

OP10 VALIDATION OF DIFFERENT RESPONSES OF THE SUDOMOTOR

FUNCTION TEST (NEUROPAD) IN IDENTIFYING TYPE 2 DIABETIC

PATIENTS WITH PERIPHERAL OVERALL NERVE DYSFUNCTION

A multicenter study

Manes Christos, Papanas Nikolaos, Exiara Triada, Papantoniou Stefanos,

Kirlaki Evridiki, Tsotoulidis Stefanos, Kefalogiannis Nikolaos,

Maltezos Efstratios

OP11 DIFFERENT RESPONSES OF A SCREENING TOOL (SUDOMOTOR FUNCTION

TEST) IN IDENTIFYING TYPE 2 DIABETIC PATIENTS WITH SMALL FIBER

NERVE DYSFUNCTION

A multicenter study

Manes Christos, Papanas Nikolaos, Exiara Triada, Papantoniou Stefanos,

Kirlaki Evridiki, Tsotoulidis Stefanos, Kefalogiannis Nikolaos,

Maltezos Efstratios

16:00-17:30 Oral Presentations

Chairs: I. Apostolakis, A. Kamaratos

OP12 THE ROLE OF HYPERTENSION AND OBESITY IN THE NEUROPATHIC

AND MICROANGIOPATHIC COMPLICATIONS OF DIABETES TYPE 2

O. Tsachouridou, S. Tsotoulidis, G. Petridis, K. Grivou, S. Papathoma,

S. Sidiropoulou, A. Matis, A.Tsachouridis, D. Karagiannidou, D. Pavlidou

OP13 MACROVASCULAR COMPLICATIONS AND RISK FACTORS,

COEXISTENCE, THEIR ROLE IN THE PATHOGENESIS AND THE

SEVERITY OF DIABETIC FOOT

D. Skoutas, N. Papanas, Z. Mousleh, S. Giandikidis, K. Siomos, G. Georgiadis,

V. Souftas, N. Papazoglou, M. Lazaridis, Ch Manes

OP14 STUDY OF DIABETIC NEUROPATHY AND RETINOPATHY IN PATIENTS

WITH DIABETES TYPE 2 IN CORRELATION WITH THE DURATION AND

EFFECTIVE MANAGEMENT OF THE DISEASE

Ο. Tsachouridou, S. Tsotoulidis, G. Petridis, K. Grivou, S. Sidiropoulou,

S. Papathoma, A.Tsachouridis, A. Sbardos, D. Mikropoulos, A. Matis,

M. Tsetselidou

OP15 HEREDITY AND DIABETIC NEUROPATHY AND RETINOPATHY

IN PATIENTS WITH DIABETES TYPE 2

S. Tsotoulidis, G. Petridis, O. Tsachouridou, K. Grivou, A.Tsachouridis,

S. Sidiropoulou, S. Papathoma, D. Mikropoulos, A. Psarra, M. Tzovanaki

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OP16 NECROTIZING SOFT TISSUE INFECTIONS OF THE DIABETIC FOOT:

AN EMERGENCY SITUATION

C. Loupa, M. Skopeliti, D. Chryssis, M. Fatourou, I. Bakas, E. Voyatzoglou,

A. Donou, G. Marathonitis, D. Voyatzoglou†

OP17 USE OF VACUUM-ASSISTED CLOSURE (VAC) DEVICE IN A DIABETIC

FOOT CLINIC

C. Loupa, E. Meimeti, A. Donou, E. Voyatzoglou, I. Bakas, D. Voyatzoglou†

OP18 SUCCESFUL TREATMENT OF SELECTED CASES OF OSTEOMYELITIS

IN THE DIABETIC FOOT WITHOUT SURGICAL BONE REMOVAL

C. Loupa, Ι. Kotsantis, Ε. Papadakis, Ε. Voyatzoglou, Μ. Skopeliti, Α. Donou,

Κ. Papagiannis, Ε. Koutsantoniou, S. Lafoyanni

OP19 REPRODUCIBILITY OF THE LANARKSHIRE OXIMETRY (LOI) INDEX IN

TYPE 2 DIABETES MELLITUS

Papanas N., Kakagia D., Tiaka E., Alexandridou M., Pagkalos A., Kyrgiannaki V.,

Maltezos E.

OP20 IS TISSUE OXYGENATION A MAJOR DETERMINANT OF ULCER

OUTCOME IN DIABETIC PATIENTS?

C. Manes, Th. Mesimeris, Th Melekos, St. Stefanidou, E. Pertsas, G. Tzatzagou,

D. Mpaltzis, B. Kourkoumpas

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DAY 3

Saturday 9 July, 2011


08:45-09:30 Debate: Treatment strategies for the diabetic foot

Chairs: P. Balas, D. Raithel

08:45-09:00 Efforts for limb conservation: when and how?: C. Liapis

09:00-09:15 Virtual Amputation: a new procedure to salvage the diabetic foot: E. Calabrese

09:15-09:30 The chair opinion for a consensus: P. Balas, D. Raithel

09:30-11:00 Round Table:Conventional treatment of the diabetic foot

Chair: E. Bastounis

09:30-09:45 Radical foot amputations: what are the benefits?: F. Markatis

09:45-10:00 Distal by-pass procedures can reduce limb loss: D. Kiskinis

10:00-10:15 Can drug - therapy, be efficient in the management of the diabetic foot?angiogenic growth factors, prostaglandins: S. Georgopoulos

10:15-10:30 What is the role of lumbar sympathectomy in 2011, for the management of diabetic foot lesions?: A. Giannoukas

10:30-10:45 Neuro - stimulation of the spinal cord: what is its place in the diabetic patient?: K. Ktenidis



11:30-14:45 Round Table:Endovascular limb salvage of the diabetic patient

Chairs: D. Kiskinis, P. Bergeron

11:30-11:45 Specificities of diabetic arteries: U. Meister

11:45-12:00 Anatomic consideration for successful recanalisation, the tibio - peronealrunoff scoring and the JENALI collateral score: R. Pini

12:00-12:15 Recanalisation of subtotal occlusions: the role of atherectomy and newdevices (Jetstream): K. Papazoglou

12:15-12:30 Recanalisation of chronic total conclusion with subintimal angioplasty: L. Inglese

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12:30-12:45 Alternative collateral way: K. Ktenidis

12:45-13:00 Efficacy of below the knee (BTK) balloon angioplasty, cryoplasty and drugeluting balloons: K. Kalligianni

13:00-13:15 BTK stenting for tibio-peroneal lesions in critical limb ischaemia patients: W. Ritter

13:15-13:30 Treatment strategies of acute limb ischaemia in the diabetic patient. Thrombectomy, aspiration, thrombolysis: S. Kalliafas

13:30-13:45 New medical treatment in the diabetic foot: negative pressure therapy:A. Dionyssopoulos

13:45-14:00 Treatment with hyperbaric O2 in the diabetic foot: T. Mesimeris

14:00-14:15 Combined endovascular and surgical procedures. The “hybrid” era: P. Bergeron


14:45-16:30 Break

16:30-17:30 Round Table:Update in diabetic neuropathy

Chairs: N. Tentolouris, T. Katsaros

16:30-16:45 Chronic sensorimotor neuropathy: C. Manes

16:45-17:00 Autonomic neuropathy in diabetic foot: N. Papanas

17:00-17:15 Painful diabetic neuropathy: J. Doupis



17:45-19:00 Round Table: Contemporary approaches in the treatment of diabetes mellitus andits implications

Chair: C. Manes

17:45-18:15 Ertapenem in the diabetic foot infections: N. Tentolouris

18:15-18:45 Sitagliptin΄ s position in the therapeutic algorithm: E. Hatziagelaki


19:00-19:15 Conclusions

P. Bergeron, C. Manes

21:00 Gala Dinner

SpeakersIndex

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Bergeron P. Dr., French Surgical Academy Member, Head Department of Cardiovascularand Thoracic Surgery, St Joseph Hospital & Foundation, France, Directorof Multidisciplinary European Endovascular Therapy

Calabrese E. Diplomate of the American Board of Surgery, Director, International Centerfor Limb Salvage, G.F.M.E.R.: Geneva Foundation for Medical Educationand Research - Geneva, Switzerland, Director, National Center for LimbSalvage, Monza Policlinic - Milan, Italy

Inglese L. Dr., Professor of Interventional Radiology IRCCS Policlinic S. Donato, Milan,Italy

Μeister U. Dr., Chief of the Department of Vascular Surgery, Hospital of Neumarkt,Germany

Pini R. MD, Vascular Interventional Radiologist, Department of Vascular andInterventional Radiology,S. Giovanni Battista - Molinette Hospital, Turin, Italy

Raithel D. Dr., Professor of Vascular Surgery, Nuremberg Hospital, Germany, HonoraryDirector of Multidisciplinary European Endovascular Therapy

Ritter W.O. Leader of the Department of Interventional Radiology Klinikum NüernbergSued, Germany

INTERNATIONAL FACULTY

Adamopoulos C. ΜD, PhD, Cardiologist, Department of Cardiology, General Hospital“Αg. Pavlos”, Thessaloniki

Apostolakis I. Physician, Director of 1st Internal Medicine Department, Chief MedicalOfficer, “Hygeia” Hospital, Athens

Balas P. MD, MS (Surg.), FACS (Hon.), Emeritus Professor of Surgery, AthensUniversity Medical School, Athens

Bastounis E. Professor Emeritus of Surgery, Athens University Medical School,Vascular Surgeon, Athens

Bintoudi A. Consultant Radiologist, MSK Department, “Papageorgiou” TeachingGeneral Hospital, Thessaloniki

Diamandopoulos A. Professor of Athens University Medical School, Ex Director ofDepartment of Nefrology, “Ag. Andreas” General Hospital, Patra

LOCAL FACULTY

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Dimitroulis D. Senior Lecturer in Surgery and Transplantation, 2nd Department ofPropaedeutic Surgery Medicine, Athens University Medical School,“Laiko” General Hospital, Athens

Dionyssopoulos A. Associate Professor of Plastic Surgery, Faculty of Medicine, AristotleUniversity of Thessaloniki, Thessaloniki

Dounis E. MD, F.A.C.S., Orthopaedic Surgeon, Foot and ANKLE Surgery,Athens

Doupis J. MD, PhD, Director of Internal Medicine and Diabetes Department,Naval Hospital, Salamis Naval Base, Athens

Georgopoulos S. Assistant Professor of Vascular Surgery, 1st Department of VascularMedicine, Athens University Medical School, “Laiko” General Hospital,Athens

Giannopoulos A. Professor of Surgery, 1st Department of Surgery, Athens UniversityMedical School, “Laiko” General Hospital, Athens

Giannoukas A. Professor of Vascular Surgery, Faculty of Medicine, University ofThessalia, Larissa

Hatziagelaki E. Assistant Professor of Internal Medicine, 2nd Department of InternalMedicine Propaedeutic - Research Institute and Diabetes Center,Athens University Medical School, University General Hospital“Attikon”, Athens

Kalliafas S. Vascular - Endovascular Surgeon, Director in the Department ofVascular Surgery, “Hygeia” Hospital, Athens

Kalligianni K. MD, PhD, Vascular Surgeon, “Hygeia” Hospital, Athens

Kamaratos A. Assistant Director in the Diabetic Center, “Tzaneio” General Hospital,Piraeus

Katsaros T. Internist specialized in diabetes, Director in Chief of EndocrinologyDepartment, Athens General Hospital “G. Gennimatas”, Athens

Katsilambros L.N. Professor of Internal Medicine, M.D., PhD, FACP, University ofAthens, Research Laboratory “N.S.Christeas” & “EvgenidionHospital”, Vice President of the Hellenic National Diabetes Center,Vice President of the Hellenic Society of Internal Medicine, Athens

Kiskinis A.D. Professor of Vascular Surgery, MD, Director of 1st Department ofSurgical Clinic, Aristotle University of Thessaloniki, General Hospital“Papageorgiou”, Thessaloniki

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Kokkinos A. Lecturer in Internal Medicine, 1st Department of Propaedeutic andInternal Medicine, Athens University Medical School, “Laiko” GeneralHospital, Athens

Ktenidis K. Assistant Professor of Vascular Surgery, 1st Department of VascularSurgery, Aristotle University of Thessaloniki, General Hospital“Papageorgiou”, Thessaloniki

Loupa C. Internist, Infectious Diseases Physician, “Amalia Fleming” GeneralHospital, Athens

Liapis C. Professor of Vascular Surgery University of Athens, ChairmanDepartment of Vascular Surgery, University General Hospital“Attikon”, Athens

Makrilakis K. Assistant Professor of Internal Medicine, 1st Department of Propaedeuticand Internal Medicine, Athens University Medical School, “Laiko”General Hospital, Athens

Manes C. MD, PhD, Internal Medicine, Chairman of the Diabetic Departmentof “Papageorgiou” Teaching General Hospital, Thessaloniki,President of the Hellenic Association for the Study of the DiabeticFoot

Markatis F. Dr., MD, Vascular Surgeon, Clinical Fellow Department Cardio -Thoracique et Gros Vaisseaux, Hospital Saint - Joseph, Marseille,France

Mesimeris Τ. Medical Director of Hyperbaric Medicine Department, GeneralHospital “Αg. Pavlos”, Thessaloniki

Papazoglou E. General Surgeon, Specialized in Diabetic Foot, Piraeus

Papazoglou K. Associate Professor of Vascular Surgery, 5th Department of VascularMedicine, Aristotle University of Thessaloniki, General Hospital“Hippokration”, Thessaloniki

Papanas N. Assistant Professor of Internal Medicine, Outpatient Clinic of theDiabetic Foot, 2nd Department of Internal Medicine, DemocritusUniversity of Thrace, University General Hospital of Alexandroupolis,Alexandroupoli

Plachouras D. Assistant Professor of Internal Medicine - Infectious Diseases, 4th Department of Internal Medicine, Athens University MedicalSchool, University General Hospital “Attikon”, Athens

Polymeros S. Dr., “Mitera” Hospital, Ygeia Polis, Consultant Cardiologist, Glasgow,UK

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Petrikkos G. Professor of Internal Medicine - Infectious Diseases, Director of the4th Department of Internal Medicine, Athens University MedicalSchool, University General Hospital “Attikon”, Athens

Pyrgakis N.V. MD, FESC, FACC, Chairman of Cardiology Department, AthensGeneral Hospital “G. Gennimatas”, Former President of the HellenicCardiological Society, Athens

Raptis S.A. Professor M.D., PhD., M.D. (Hon), HMGSIM, HFEFIM, Academicianand Senate Member of the European Academy of Sciences and Arts,Internal Medicine, Endocrinology and Gastroenterology, Universitiesof Athens - Hellas and Ulm - Germany, 2nd Department of InternalMedicine Propaedeutic - Research Institute and Diabetes Center,Athens University Medical School, University General Hospital“Attikon”, President of the Hellenic National Diabetes Center, Athens

Rokkas C. Associate Professor of Cardiothoracic Surgery, Director in Chief ofCardiothoracic Surgery Department, Athens University MedicalSchool, University General Hospital “Attikon”, Athens

Sayegh F. Assistant Professor of Orthopaedics, 3rd Department of Orthopaedics,Aristotle University of Thessaloniki, General Hospital “Papageorgiou”,Thessaloniki

Tentolouris N. Assistant Professor of Internal Medicine, 1st Department of Propaedeuticand Internal Medicine, Athens University Medical School, “Laiko”General Hospital, Athens

Thanopoulou A. Lecturer in Internal Medicine and Diabetes Mellitus, 2nd Departmentof Internal Medicine, Athens University Medical School, “Hippocration”General Hospital, Athens

Thiaspras L. Podiatrist, Athens

Theodorakis M. Head, Diabetes Foot and Angiopathy Clinic, Evgenideion Infirmary,University of Athens, Athens

Tsitouridis I. Chairman of Radiology Department, General Hospital “Papageorgiou”,Thessaloniki

Valsami M. MSc, BSc, Podiatrist, Specialized in Diabetic Foot, “Laiko” GeneralHospital, Athens

OralPresentations

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Oral Presentations OP1

MICROVASCULAR COMPLICATIONS AND RISK FACTORS, COEXISTENCE, THEIRROLE IN THE PATHOGENESIS AND THE SEVERITY OF DIABETIC FOOT

D. Skoutas1, N. Papanas2, Z. Mousleh3, S. Giandikidis4, G. Tsiantas1, S. Georga5, Th. Mesimeris6,N. Papazoglou1, M. Lazaridis7, Ch. Manes1

1 Department of Internal Medicine and Diabetic Centre, University Hospital G. Papageorgiou, Thessaloniki2 Second Department of Internal Medicine, Democritus University of Thrace3 IKA of Analipsi, Thessaloniki4. General Hospital of Katerini5 Laboratory of Nuclear Medicine, University Hospital G Papageorgiou, Thessaloniki6 Hyperbaric Unit, General Hospital “Agios Pavlos”,Thessaloniki7 Vascular surgery Department, Democritus University of Thrace

Introduction: The microvascular complications (diabetic retinopathy and nephropathy), except ofcourse of the neuropathy that constitutes the main reason of diabetic foot, coexist and affect, asmicroalbuminuria is distinguished, in the development of the Diabetic Foot (DF).

Aim: The detection of coexistence and the relation of retinopathy and nephropathy in the pathogenesisand in the severity of DF.

Patients - Methods: Our material of 256 patients (171 male, 85 female) with “diabetic foot” thatrecorded, monitored and likely hospitalized for this reason. We have complete data concerning only250 of them, aged 65,31±10,25 years, mean HbA1c: 8,65±1,7%, of duration of diabetes 15,84±9,2 yearsand 32% of them are active smokers. The history of the reason which caused the lession is taken andpatients are examined for neuropathy, and peripheral arterial disease (NDS, VPT, ABI are measured).

11,2% of our patients was not detected with nephropathy, while 37,3% of them have microalbuminuria,39,8% of the patients have macroalbuminuria and 11,6% of the total number has end-stage renal failure.

The existence or not of diabetic retinopathy (DR) was recorded and we have 175/215 patients with DR(81%) that has been examined, by that the 93/234 (40%) had already done laser photocoagulation,while 15 patients are blinded.

Results: 87 (34 %) of our patients have neuropathic lessions, a number of 34 (13,3%) purely ischaemicand another 120 (46,9%) neuroischaemic lessions. The existence of DR appears to have strong cross-correlation with the pathogenesis of DF (p<0,021), after 52,1% of patients with DR have neuroischaemiclessions and 37,3% of them have neuropathic. There is no cross-correlation with the severity of thelession (p< 0,121).

We observe the appearance of retinopathy in 11 years of diabetes in patients with neuropathy or bothneuropathy and ischaemia, while in patients with purely ischaemic lessions in 7,5 years. There was nosignificant difference between the duration of DR and the type of the lession (p=0,269). The duration ofDR does not appear to relate itself with the severity of the ulcer (p=0,208).

The cross-correlation of the type of nephropathy with the pathogenesis of DF (p<0.044) is obvious andespecially with neuropathy, since 48,3% of the individuals with nephropathy have neuroischaemic and38,0% of them have neuropathic lessions, while does not exist cross-correlation with the severity of DF(p<0,383).

Conclusion: The coexistence of microvascular complications in patients with DF is obvious withincreased frequency, probably because of poor metabolic control and self-monitoring, as well as therole of the retinopathy and nephropathy in the pathogenesis of DF, particularly among patients withneuropathy.

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PREVENTION AND MANAGEMENT OF THE DIABETIC FOOT - OUR EXPERIENCEFROM OUR NEW DIABETIC FOOT CLINIC

Bristianou M., Panou Ch., Chatzidakis I., Tsiligrou V., Mytis G., Lanaras L.

Lamia General Hospital, Greece

Aim: The classification of the diabetic ulcers of the lower extremities and the epidemiological data ofthe diabetic patients who visited the Diabetic Foot Clinic of our hospital, a clinic which provides medicalservices to the public since March 2011.

Materials - Methods: Twenty-one patients participated in this study; these patients had visited theDiabetic Foot Clinic in a 3-month period starting from last March to last June. The patients wereregistered and the following data were recorded: age, gender, profession, comorbidities, medicationas well as the reason for a diabetic foot clinic visit. Complete laboratory tests, examination for peripheralneuropathy and vessel triplex (if it was necessary) were performed.

Results: Of those 21 patients, aged 59±10.5 years and duration of diabetes 12±10.2 years, 7 (33.3%)were women and 14 (66.6%) were men. Of those 7 women, 5 (71.4%) were housewives and only 2(28.5%) were employed. Of the 14 men, 5 were working in the private sector, 2 were working in thepublic sector, 2 were farmers, 1 was unemployed and 4 were pensioners. 3 (14.2%) had neuropathiculcers, 4 (23.8%) neuroischemic ulcers, 8 (38.09%) came for preventive examination and 6 (28.5%)visited the clinic for other reasons (cellulitis, painful diabetic neuropathy, second opinion, curiosity …).

Conclusion: Although the Diabetic Foot Clinic was a new clinic in our hospital, our small sample showsthat the operation of these clinics is essential because they can decrease the morbidity and the mortalityof the diabetic foot and they can diminish the amputations and the overall time of hospitalization of thediabetic patients.

22


OSTEOPROTEGERIN LEVELS CORRELATE WITH SEVERITY OF PERIPHERAL ARTERIALDISEASE AND PERIPHERAL NEUROPATHY IN TYPE 2 DIABETIC PATIENTS

Eleftheriadou Ioanna1, Grigoropoulou Pinelopi1, Argiana Vasiliki1, Balla Ioanna1, ChorepsimaStamatina1, Kokkinos Alexander1, Perrea Despoina2, Katsilambros Nicholas1, Tentolouris Nicholas1

1 First Department of Propaedeutic and Internal Medicine, Athens University Medical School, Laiko GeneralHospital, Greece

2 Laboratory of Experimental Surgery and Surgical Research, Athens University Medical School, Greece

Introduction: Increased osteoprotegerin (OPG) levels have been found in diabetic patients with micro-and macrovascular complications. Recent studies have shown that OPG concentrations correlate withseverity of peripheral arterial disease (PAD) in patients without type 2 diabetes mellitus (T2DM).However, no data exist on the association between OPG levels and severity of PAD and peripheralneuropathy (PN) in patients with T2DM.

Purpose: The aim of this study was to look for potential association between OPG levels and severityof PAD and PN in patients with T2DM.

Methods: A total of 74 patients with T2DM were recruited (mean age 67.8±9.0 years, duration ofdiabetes 15.3±10.9 years). Serum OPG levels were measured using ELISA. PAD was diagnosed bymeans of ankle-brachial index (ABI≤0.9). Patients with ABI values>1.3 were excluded from furtheranalysis. Diagnosis of PN was based on neuropathy disability score (NDS) and vibration perceptionthreshold (VPT).

Results: Patients with PAD (n=27) had significantly higher serum OPG levels in comparison with thosewithout PAD (18.0±4.9 vs. 14.8±4.8 pmol/l, p<0.001). Patients with PN (n=36) had also higher OPGlevels than patients without PN (17.1±5.8 vs. 15.0±4.0 pmol/l, p<0.011). OPG levels were significantlyassociated with ABI (r=-0.309, p<0.001), VPT (r=0.370, p<0.001) and NDS (r=0.324, p<0.001). Theassociation between OPG concentrations and ABI remained significant after adjustment for age,diabetes duration, sex and presence of PN. The associations between OPG levels and VPT, NDSremained significant after adjustment for age, diabetes duration, sex and presence of PAD.

Conclusion: Serum OPG levels are increased in diabetic patients with either PAD or PN and areassociated independently with the severity of these complications.

23


SERUM OSTEOPROTEGERIN LEVELS CORRELATE WITH SEVERITY OF LOWER EXTREMITY ARTERIAL CALCIFICATION IN PATIENTS WITH TYPE 2 DIABETES

Eleftheriadou Ioanna1, Argiana Vasiliki1, Grigoropoulou Pinelopi1, Balla Ioanna1, Kritikos Constantinos1, Arapostathi Christina1, Kokkinos Alexander1, Perrea Despoina2, KatsilambrosNicholas1, Tentolouris Nicholas1



Introduction: Recent studies have shown that osteoprotegerin (OPG) concentrations correlate withcoronary artery calcification in patients with type 2 diabetes mellitus (T2DM). However, no data existson the association between OPG concentrations with lower extremity arterial calcification (LEAC) inpatients with T2DM.

Purpose: The aim of this study was to look for potential association between OPG levels and severityof LEAC in patients with T2DM.

Methods: A total of 74 patients with T2DM were recruited (mean age 67.8±9.0 years, duration ofdiabetes 15.3±10.9 years). Serum OPG levels were measured using ELISA. In all patients radiographswere taken of both feet and ankles. LEAC was graded in a scale from 0-5 at 4 locations (posterior tibialand dorsalis pedis arteries bilaterally). The total LEAC score (0-20) at all 4 locations was calculated.Diagnosis of peripheral arterial disease (PAD) was based on the absence of triphasic waveform at theposterior tibial artery, while diagnosis of PN on neuropathy disability score (NDS) and vibrationperception threshold (VPT).

Results: Patients without or with less LEAC (grade 0-2 based on the maximum LEAC grade at one outof 4 locations; n=44) had lower OPG levels compared with patients with more severe LEAC (grade 3-5;n=30) (15.0±4.4 vs 18.6±6.0 pmol/l, p<0.001). The total LEAC score was significantly associated withage (r=0.23, p=0.011), pulse pressure (r=0.41, p<0.001), glomerular filtration rate (r= -0.20, p= 0.026),albumin-to-creatinine ratio (r=0.36, p<0.001), VPT (r=0.26, p=0.002) and OPG levels (r= 0.25, p=0.004).The association between the total LEAC score and OPG concentrations remained significant afteradjustment for age, GFR, diabetes duration and PN status.

Conclusion: Serum OPG levels are associated with severity of LEAC in patients with T2DM.

24


POPLITEAL ARTERY PERCUTANEOUS TRANLUMINAL ANGIOPLASTY FOR CHRONICCRITICAL LIMB ISCHEMIA AND DIABETES MELLITUS LESIONS. ANALYSIS OF A SINGLE-CENTER EXPERIENCE

Argitis V., Kyriakidis K.,Tabakis H, Dervisis K.

Department of Vascular Surgery, Konstantopoulio General Hospital "Agia Olga", N. Ionia, Athens, Greece

Introduction: This study assessed the three year outcome of patients with critical limb ischemia,Fontaine 3 & 4 and diabetic feet with calcific ankle arteries (> 60%) who had undergone balloon PTA.

Purpose: Treat patients with chronic lower limb ischemia and diabetic lesions by using endovasculartechniques-balloon PTA.

Methods: Ten patients treated with Ipsilateral access PTA with high pressure low profile balloons (10Atm) of 2-4mm diameter and 400mm length. Guidewires of 0,014” inches and hydrophilic wires of 0,035inches.

Results: Three years meta analysis with technical success (no complications by surpassing theocclusion). Primary patency - 88%.

Limb salvage 90%. Tissue loss was a bad predictive sign only for the limb patency but not for the limbsurveillance.

Conclusion: PTA appears to be the treatment of choice in patients with popliteal lesions due to chronicobstructive disease and diabetes mellitus. Balloon angioplasty can be successful even in long lesionswith the least complications and mortality. Unsuccessfulness of the method does not exclude an openbypass operation moreover it appears to be a repeatable method in case of restenosis.

25


PLEIOTROPIC EFFECTS OF ATORVASTATIN ON CENTRAL AND PERIPHERAL ARTERIESOF PATIENTS WITH TYPE 2 DIABETES

P. Grigoropoulou1, I. Eleftheriadou1, C. Zoupas1, V. Argianna¹, A. Kokkinos1, D. Perrea2, N. Katsilambros1, N. Tentolouris1

1 1st Department of Propaedeutic Medicine, Athens University Medical School, Laiko Hospital, Athens, Greece2 Laboratory of Experimental Surgery and Surgical Research, Athens University Medical School, Athens,

Greece

Introduction: Dyslipidaemia is a modifiable atherogenic risk factor in patients with type 2 diabetes.Statins have been proved to significant reduce cardiovascular morbidity in large clinical trials. Increasedarterial stiffness, assessed by pulse wave velocity (PWV), has emerged as an independent predictor ofcardiovascular events.

Purpose: The aim of this prospective study was to evaluate the effect of atorvastatin administration for1 year on arterial stiffness in patients with type 2 diabetes.

Methods: A total of 54 patients were recruited, 31 patients were assigned to 12-months atorvastatintherapy (10 mg daily) and a low fat diet, and 23 patients to low-fat diet only. The two groups werecomparable at baseline in terms of lipids, body mass index, diabetes duration, age and HbA1c. Themain inclusion criteria were LDLc ≥100 mg/dl and absence of macrovascular disease. PVW wasdetermined by applanation tonometry (SphygmoCor Vx, AtCor Medical, Sydney, Australia) along thecarotid- femoral (PWVcf) and the carotid-radial (PWVcr) arteries. Plasma lipids, HbA1c, and PVW wereevaluated prospectively at baseline, 3, 6, and 12 months in both groups.

Results: Total cholesterol and LDLc declined significantly in the atorvastatin-treated group at theexamined time intervals. In the same group a significant reduction in PWVcr and PWVcf was observedat 3 months (4.59 %, p<0.001, and 9.18 %, p<0.001), which was maintained at 6 (6.55 %, p=0.007, and12.99 %, p<0.001) and 12 months (9.9%, p=0.01, and 12.43%, p=0.003, respectively). In the diet treatedgroup no significant changes of PWVcr and PWVcf were found.

Conclusion: A low dose of atorvastatin improves arterial stiffness in patients with T2DM.

26


BULLOSIS DIABETICORUM: A NOT-SO-RARE CONDITION CHARACTERISTIC OF DIABETES MELLITUS

C. Loupa, E. Voyatzoglou, A. Donou, N. Souliotis, E. Meimeti, D. Voyatzoglou†

Demetrios Voyatzoglou Diabetic Foot Clinic, A. Fleming General Hospital, Athens, Greece

Introduction: Bullosis diabeticorum is considered a rare and relatively harmless skin manifestation withpainless, tense, superficial blisters appearing rapidly and abruptly in diabetic persons, usually on thefeet and lower legs, without preceding trauma. The bullae arise from a noninflamed base, are usuallymultiple, and vary in size from 1 to several cm. The bullae rupture in approximately 1 week, leaving adeep, painless ulcer that forms a firmly adherent crust. They commonly heal in 2-6 weeks withoutscarring, but complications such as secondary bacterial infection or hemorrhage may occur. Manypatients never have another episode, whereas others have recurrences. Most papers report only a fewcases and the cause of the blisters is unknown, but is possibly ischemic.

Patients: We describe 6 patients with bullosis diabeticorum, 4 men/2 women, all with T2DM.Characteristics of these patients are summarized in the following Table.

I: insulin, OA: oral hypoglycemic agents, Y=yes, N=no, Tx=treatment, Abx=antibiotics

In all 6 patients, bullae either ruptured spontaneously or were perforated in the clinic, and clear yellowishsterile fluid came out. In 2 out of 6 patients antibiotics were prescribed because of superinfection, and2 more patients were already on antibiotics because of another ulcer complicated with osteomyelitis.There was complete healing of lesions in all patients.

Conclusion: We have experienced that the lesions are not so rare. Although the containing fluid issterile, it is very easy that a secondary infection occurs after rupture, so antibiotic treatment is necessaryin many cases. Bullae heal completely in several weeks’ time.

Px Sex Age Type of DM HbA1c (%) Duration Tx of DM Localization Size Abx

of DM (yrs) of bullae (cm)

1 M 79 2 5 17 I Foot 7,5 Y

2 M 59 2 5,8 10 I Lower leg 3 Y

3 M 60 2 9,6 20 I Foot 2,5 Y

4 M 72 2 7,5 25 I Lower leg 3,5 N

5 F 90 2 6,8 4 OA Lower leg 2 Y

6 F 77 2 10,1 0 - Upper leg 2,5 N

27


THE ASSOCIATION BETWEEN DIABETIC AUTONOMIC NEUROPATHY AND CUTANEOUSCIRCULATION IN PATIENTS WITH TYPE 2 DIABETES

Eleftheriadou Ioanna1, Grigoropoulou Pinelopi1, Argiana Vasiliki1, Fardi Panagiota1, KalopitaStavroula1, Alexiadou Kleopatra1, Kokkinos Alexander1, Perrea Despoina2, Katsilambros Nicholas1, Tentolouris Nicholas1



Introduction: Transcutaneous oxygen tension (TcPO2) reflects the cutaneous microvascular perfusionstatus and TcPO2 levels are reduced in patients with type 2 diabetes mellitus (T2DM).

Purpose: The aim of this study was to examine the potential effect of cardiac autonomic neuropathy(CAN) on cutaneous circulation assessed by determination of TcPO2 in patients with T2DM.

Methods: A total of 100 patients with T2DM were recruited (mean age 66.5±8.7 years, duration ofdiabetes 14.0±10.8 years). TcPO2 was measured using a TCM30 system and the electrode was placedon the dorsum between the first and second metatarsal heads. Diagnosis of CAN was based on thebattery of the four autonomic function tests proposed by Ewing. Diagnosis of peripheral arterial disease(PAD) was based on the absence of triphasic waveform in the posterior tibial artery, while of peripheralneuropathy (PN) on neuropathy disability score (NDS) and vibration perception threshold (VPT).

Results: A total of 20 subjects had CAN. Subjects with CAN had more often PAD and PN and lowerTcPO2 levels in comparison with subjects without CAN (43.6±15.0 vs. 49.1±11.1 mmHg, p=0.033).Univariate linear regression analysis showed that diabetes duration, HbA1c values, presence of PAD,presence of PN and presence and severity of CAN were significantly and negatively associated withTcPO2. Model 1 of the multivariate analysis demonstrated that after adjustment for gender, age, durationof diabetes and HbA1c levels, severity of CAN and presence of PAD were significantly and negativelyassociated with TcPO2. Model 2 showed that after controlling for gender, age, diabetes duration andHbA1c values, severity of CAN and presence of PN were significantly associated with lower TcPO2

levels.

Conclusion: Presence and severity of CAN is associated with reduction in cutaneous perfusionirrespective of the presence of PAD or PN.

28


ASSOCIATION OF ARTERIAL STIFFNESS AND CARDIOVASCULAL RISK FACTORS INPATIENTS WITH TYPE 2 DIABETES

P. Grigoropoulou1, I. Eleftheriadou1, C. Zoupas1, V. Argianna¹, I. Balla1, A. Kokkinos1, D. Perrea2, N. Katsilambros1, N. Tentolouris1

11st Department of Propaedeutic Medicine, Athens University Medical School, Laiko Hospital, Athens, Greece2 Laboratory of Experimental Surgery and Surgical Research, Athens University Medical School, Athens,

Greece

Introduction: Increased arterial stiffness represents the link between diabetes and increasedcardiovascular disease. Aortic pulse wave velocity (aPWV) has emerged as an independent predictorof cardiovascular morbidity and mortality in patients with diabetes.

Purpose: Aim of our study was to evaluate the association between aPWV and cardiovascular riskfactors (new and classic) in patients with type 2 diabetes.

Methods: A total of 163 patients (74 men, 89 women, mean age 62,59±8,97 yrs) with type 2 diabetesand no apparent clinically macrovascular disease were assessed. We assessed basic clinical anddemographical characteristics. Plasma glucose, creatinine, HbA1c, fibrinogen, plasma osteoprotegerin(OPG), hsCRP, GFR and urine albumin/creatinine ratio (A/Cu) were evaluated. aPWV was determinedby applanation tonometry (SphygmoCor Vx, AtCor Medical, Sydney, Australia) along the carotid-femoral.

Results: In the total patients enrolled, 127 (65.8%) had plasma LDLc >100 mg/dl, 81 (42%) patientswere under statin therapy, 120 (62.2%) had hypertension, 39 (20.2%) patients suffered from peripheralneuropathy, and 34 (33%) were smokers. Linear regression analysis showed that aPWV was signifiacantassociated with age (p<0.001), BMI (p=0.025), diabetes duration (p=0.006), OPG (p=0,002), Α/Cu(p=0,006), plasma creatinine (p=0.009), calculated GFR (p<0.001), presence of peripheral neuropathy(p<0.001) and pulse pressure (p<0.001). No significanw association was observed between aPWV andarterial pressure, smoking, plasma lipids, hbA1c, waist circumference, waist-to-hip ratio and hsCRP.

Conclusion: In patients with type 2 diabetes, beyond classic risk factors, new factors, such awperipheral neuropathy and OPG are associated with arterial stiffness.

29


VALIDATION OF DIFFERENT RESPONSES OF THE SUDOMOTOR FUNCTION TEST(NEUROPAD) IN IDENTIFYING TYPE 2 DIABETIC PATIENTS WITH PERIPHERAL OVERALL NERVE DYSFUNCTION

A multicenter study

Manes Christos, MD1, Papanas Nikolaos, MD2, Exiara Triada, MD1, Papantoniou Stefanos, MD3,Kirlaki Evridiki, MD4, Tsotoulidis Stefanos, MD5, Kefalogiannis Nikolaos, MD4, Maltezos Efstratios,MD2

1 Diabetes Center, General Hospital “PAPAGEORGIOU” Thessaloniki, Greece2 Diabetic Foot Clinic, 2nd Department of Internal Medicine, Dimokritus University of Thrace, Alexandroupolis,

Greece3 Diabetes Clinic, Department of Internal Medicine, General Hospital of Kavala, Greece 4 Diabetes Unit, Venizelion Hospital, Heraklion, Kreta, Greece5 Health Center, Kassandria, Halkidiki, Greece

Objective: To investigate the utility of different responses of the indicator test for Sudomotor function(SFT) for the detection of overall fiber dysfunction in diabetic patients.

Research Design and Methods: The study included 1010 type 2 diabetic patients. Assessments ofoverall nerve fiber dysfunction were diagnosed and graded clinically using the Neuropathy DisabilityScore (NDS). The SFT was applied for 10 minutes on the plantar aspect of the feet and results wererecorded as pink, patchy (blue/pink), and blue.

Results: Patients with blue SFT results were older, had a longer duration of Diabetes, and expressedmore severe overall fiber dysfunction compared to those with patchy and normal SFT response. Theabnormal SFT result defined as patchy and/or blue had 94.9% sensitivity and 70.2% specificity forneuropathy (overall fiber dysfunction). The abnormal SFT result defined as only blue had 64% sensitivityand 96% specificity for overall neuropathy while the positive predictive value was 82%.

Conclusion: The present study showed that SFN blue response performs more specific results in orderto identify diabetic patients at risk of FU. In addition SFT patchy and or blue response has betterperformance for screening purposes in order to identify diabetic patients with overall nerve fiberdysfunction.

30


DIFFERENT RESPONSES OF A SCREENING TOOL (SUDOMOTOR FUNCTION TEST) INIDENTIFYING TYPE 2 DIABETIC PATIENTS WITH SMALL FIBER NERVE DYSFUNCTION

A multicenter study

Manes Christos, MD1, Papanas Nikolaos, MD2, Exiara Triada, MD1, Papantoniou Stefanos, MD3,Kirlaki Evridiki, MD4, Tsotoulidis Stefanos, MD5, Kefalogiannis Nikolaos, MD4, Maltezos Efstratios,MD2

1 Diabetes Center, General Hospital “PAPAGEORGIOU” Thessaloniki, Greece2 Diabetic Foot Clinic, 2nd Department of Internal Medicine, Dimokritus University of Thrace, Alexandroupolis,

Greece3 Diabetes Clinic, Department of Internal Medicine, General Hospital of Kavala, Greece 4 Diabetes Unit, Venizelion Hospital, Heraklion, Kreta, Greece5 Health Center, Kassandria, Halkidiki, Greece

Background: Small-fiber neuropathy is considered as an earlier manifestation of chronic sensory motorneuropathy the main initiating factor for foot ulceration.

Objective: To investigate the utility of different responses of the indicator test for Sudomotor functionNeuropad® (SFT) for the detection of small nerve fiber dysfunction in diabetic patients.

Research Design and Methods: The study included 1010 type 2 diabetic patients. Assessments ofsmall nerve fiber dysfunction were diagnosed and graded clinically using the Neuropathy DisabilityScore (NDS). The SFT was applied for 10 minutes on the plantar aspect of the feet and results wererecorded as pink, patchy (blue/pink), and blue.

Results: Patients with blue SFN results were older, had a longer duration of Diabetes, and expressedmore severe small fiber dysfunction compared to those with patchy and normal SFT response. Theabnormal SFT result defined as patchy and/or blue had 85.6% sensitivity, 71.2% specificity for smallfibre dysfunction respectively. The abnormal SFT result defined as only blue had 64% sensitivity and96% specificity for overall neuropathy while the positive predictive value was 82%.

Conclusion: The present study showed that SFT blue response has more specific results in order toidentify diabetic patients with small fiber dysfunction. In addition SFT blue response had betterperformance for screening purposes.

31


THE ROLE OF HYPERTENSION AND OBESITY IN THE NEUROPATHIC AND MICROANGIOPATHIC COMPLICATIONS OF DIABETES TYPE 2

O. Tsachouridou, S. Tsotoulidis, G. Petridis, K. Grivou, S. Papathoma, S. Sidiropoulou, A. Matis, A.Tsachouridis, D. Karagiannidou, D. Pavlidou

Province Health Center of Kassandria, Chalkidiki, GreeceAHEPA University Hospital, 1st Internal Medicine Department, Thessaloniki Greece

Background: Increased body weight in patients with diabetes type 2, as well as the co-existence ofaggravating factors such as arterial hypertension, may accelerate the onset of diabetes complications,such as diabetic neuropathy and retinopathy.

Aim: Aim of this study was to investigate the existence or not of correlation between hypertension andBody Mass Index (BMI) with these two complications of diabetes type 2.

Patients - Methods: 342 patients (149 males and 193 females) with diabetes type 2 participated in thisstudy. The mean age was 66 years old (65 in males,67 in females), while the mean duration of diabeteswas 10.4 years for women and 7.5 for men. Vibration perception in the big toe, the ankle and the lowerpart of the shin was measured and recorded, as well as the sensation (touch, pain, cold). In all patientsthe release of tendon reflexes (patellar reflex, Achilles tendon reflex) was examined. Moreover, medicalhistory of hypertention, Body Mass Index (BMI) at the first visit and the existence of retina damage wererecorded.

Results: 250 patients (73,09%) suffered from hypertension and already receiving medication.59 wereoverweight (24 males,35 females), while 251 were obese (118 males,133 females). There is statisticalsignificance between high BMI and retinopathy (χ2=50,904, df=24, p<0.01). There is statisticalsignificance between high BMI and the pathologic release of the patella tendon reflex (χ2=208,654,df=52, p<0.01), as well as Achilles tendon reflex (χ2=76,181, df=52, p<0.05). No correlation betweenobesity and the different sensation dysfunctions of the lower limbs. Hypertension predicts independentlythe onset of neuropathic and microangiopathic disorders in the univariate statistical analysis.

Conclusion: It seems that body weight affects the function of peripheral nerve fibers, as well as otherfactors such as hypertension. Though, more perspective studies are necessary to confirm this finding.

32


MACROVASCULAR COMPLICATIONS AND RISK FACTORS, COEXISTENCE, THEIRROLE IN THE PATHOGENESIS AND THE SEVERITY OF DIABETIC FOOT

D. Skoutas1, N. Papanas2, Z. Mousleh3, S. Giandikidis4, K. Siomos1, G. Georgiadis5, V. Souftas6,N. Papazoglou1, M. Lazaridis5, Ch. Manes1

1 Department of Internal Medicine and Diabetic Centre, University Hospital G. Papageorgiou, Thessaloniki 2 Second Department of Internal Medicine, Democritus University of Thrace.3 IKA of Analipsi, Thessaloniki4 General Hospital of Katerini5 Vascular surgery Department, Democritus University of Thrace6 Radiology Department, Democritus University of Thrace

Introduction: Macrovascular complications and risk factors, such as hypertension, dyslipidaemia,except of course of the Peripheral Arterial Disease (PAD) that constitutes sovereign factor inaetiopathology of the diabetic foot, all these also affect in the development of Diabetic Foot.

Aim: The detection of coexistence and the relation of macrovascular complications and risk factors inthe pathogenesis and severity of Diabetic Foot.

Patients - Methods: Our material consists of 256 patients (171 males, 85 females) with “diabetic foot”that recorded, monitored and likely hospitalized for this reason. We have complete data concerning250 of them, aged 65,31±10,25 years, mean HbA1c: 8,65±1,7%, of duration of diabetes 15,84±9,2 yearsand 32% of them are active smokers. The history of the reason which caused the lession is taken andpatients are examined for neuropathy, and peripheral arterial disease (NDS, VPT, ABI are measured).Dyslipidaemia is observed in 29,3% (68/232) of our patients, while 79,4% (185/233) of our patientssuffers from hypertension. In 40,2 % (101 patients) there is known coronary heart disease, while the10,6% (27 patients) had a history of stroke.

Results: 87 (34 %) of our patients have neuropathic lessions a number of 34 (13,3%) purely ischaemicand another 120 (46,9%) has neuroischaemic lessions.

The presence of coronary heart disease (CHD) has an important statistical cross-correlation with thepathogenesis of the diabetic foot (p<0,002), as we recognize that 60,4% of our patients with CHD arehaving neuroischaemic lessions, 16,7% of them are having ischaemic lessions and only 22,9% of themhas neuropathic lessions. There is no cross-correlation with the severity of diabetic foot (p=0,086). Thepresence of hypertension does not appear to relate itself with the pathogenesis and the severity of thelesion (p<0,133 and p<0,577 respectively). However, there is a significant difference among the patientswith hypertension, which coexist in the 84,5% of neuroischaemic lessions, in opposite of the 72,9% ofneuropathic only.

The presence or not of dyslipidaemia does not appear to statistically relate itself neither with thepathogenesis nor with the severity of lession (p<0,413 and p<0,218 respectively). We have similar resultswith the presence of heart failure of relating itself with the pathogenesis (p<0,018) and 66% of thepatients with heart failure have neuroischaemic lessions and 13,2% of them purely ischaemic. Howeverthere is no cross-correlation with the severity of diabetic foot (p<0,751).

The history of a stroke does not related neither with the pathogenesis nor with the severity of the diabeticfoot (p<0,910 and p<0,434 respectively).

The duration of smoking also is related with the type of lession (p<0,001).

Conclusion: The coexistence of macrovascular complications, hypertension, dyslipidaemia andsmoking in patients with Diabetic Foot is obvious as well as their role into pathogenesis of the DiabeticFoot, especially among those patients who already have ischaemia.

33


STUDY OF DIABETIC NEUROPATHY AND RETINOPATHY IN PATIENTS WITH DIABETESTYPE 2 IN CORRELATION WITH THE DURATION AND EFFECTIVE MANAGEMENT OFTHE DISEASE

Ο. Tsachouridou, S. Tsotoulidis, G. Petridis, K. Grivou, S. Sidiropoulou, S. Papathoma, A.Tsachouridis, A. Sbardos, D. Mikropoulos, A. Matis, M. Tsetselidou


Background: Diabetic neuropathy and retinopathy consist two of the most severe complications ofdiabetes mellitus type 2. Numerous studies implicate bad control and longer course of the disease forthe more severe outcome of these implications.

Objectives: This study investigates the correlation of diabetic neuropathy and retinopathy with thedisease control and duration

Patients - Methods: 342 patients (149 males and 193 females) with diabetes type 2 participated in thisstudy. The mean age was 66 years old (65 in males,67 in females), while the mean duration of diabeteswas 10.4 years for women and 7.5 for men. Vibration perception in the big toe, the ankle and the lowerpart of the shin was measured and recorded, as well as the sensation (touch, pain, cold). In all patientsthe release of tendon reflexes (patellar reflex, Achilles reflex) was examined. Additionally, all of themunderwent fundoscopy (to confirm the existence of retinopathy or sclerosis of the retina vessels) andmeasurement of glycated hemoglobin in blood at their first visit.

Results: 21.2% of the patients had retinopathy damages, while 47.8% of them suffered from sclerosisof the retina vessels. From these patients, 75.3% had bad control of blood glucose (HbA1C>7), thoughthere was no statistically significant correlation between HbA1C and retinopathy (Fisher’s exact test,p=1,00) during the first screening test of the patients. More severe retinopathy was observed in themajority of the patients who suffered from diabetes type2 for more than 10 years. There is statisticallysignificant correlation between the time course of the disease for more than 10 years and the disorderof the patella tendon reflex. (χ2=5.358, df=2, p<0.05), with similar observation in the Achilles reflex(χ2=6,875, df=2, p<0.05). There is no statistical significance between the duration of the diabetes andthe pathologic perception of pain (χ2=8,810, df=3, p<0.05), as well as in the perception of cold(χ2=20,014, df=3, p<0.01) and vibrations (χ2=10,059, df=3, p<0.05). There is statistically significantdependence of retinopathy from the time course of the disease (Fisher’s exact test, p<0,01).

Conclusion: The duration of the disease and bad control of blood glucose may affect the onset andthe severity of neuropathic and microangiopathic complications of diabetes type 2.

34


HEREDITY AND DIABETIC NEUROPATHY AND RETINOPATHY IN PATIENTS WITH DIABETES TYPE 2

S. Tsotoulidis, G. Petridis, O. Tsachouridou, K. Grivou, A.Tsachouridis, S. Sidiropoulou, S. Papathoma, D. Mikropoulos, A. Psarra, M. Tzovanaki


Background: The obtaining of a fully detailed medical record and the regular follow-up of the patientswith diabetes type 2 may contribute beneficially in the prevention and control of the complications ofthe disease, anticipating its heavier consequences.

Objectives: Aim of this study is the investigation of the correlation between the heredity and those twocomplications of diabetes type 2.

Patients - Methods: 342 patients (149 males and 193 females) with diabetes type 2 participated in thisstudy. The mean age was 66 years old (65 in males,67 in females), while the mean duration of diabeteswas 10.4 years for women and 7.5 for men. Vibration perception in the big toe, the ankle and the lowerpart of the shin was measured and recorded, as well as the sensation (touch, pain, cold). In all patientsthe release of tendon reflexes (patellar reflex, Achilles reflex) was examined. Moreover, positive familyhistory of diabetes (at least one relative suffering from diabetes), Body Mass Index (BMI) and theexistence of retina damage were recorded.

Results: 210 patients (61.4%) mentioned positive family history for diabetes type 2 at least in onerelative person). 88,75% of the patients with tendon reflex disorder had positive family history. There isstatistical significant correlation between positive family history and the release of the patella tendonreflex (χ2=5,138, df=2, p<0.05). 59,2% of the patients with disorder in the sensation in the lower limbshad a positive family history. The relation between positive family history for diabetes and dysfunctionof the large nerve fibers is statistically significant (vibration disorder, χ2=7,122 , df=2, p<0.05). 80% ofthe patients with retinopathy had a positive family history for diabetes, though there was no statisticalsignificance among these two factors.

Conclusion: The existence of a positive family record for diabetes type 2, may comprise a significantfactor for the onset of complications of the disease, mainly the neuropathic disorders, pointing out theimportance of the obtaining a fully detailed medical personal and family history for the optimummanagement of patients in risk of diabetic neuropathy and retinopathy manifestation.

35


NECROTIZING SOFT TISSUE INFECTIONS OF THE DIABETIC FOOT: AN EMERGENCYSITUATION

C. Loupa, M. Skopeliti, D. Chryssis, M. Fatourou, I. Bakas, E. Voyatzoglou, A. Donou, G. Marathonitis, D. Voyatzoglou†


Introduction - purpose: Diabetes mellitus and peripheral angiopathy (PAD) are predisposing factorsfor necrotizing soft tissue infections (NSTIs), which are characterized by fulminant destruction of tissue,severe and continuous pain, systemic signs of toxicity, and a high rate of mortality. Despite the variousdifferent names that have been used, early diagnosis and appropriate treatment (antimicrobial therapy- including clindamycin - and surgical intervention) must be performed. We describe 2 cases of NSTI indiabetic patients with PAD.

Case 1: A 60-year-old man with T2DM (on insulin), coronary artery disease and PAD presented withNSTI (necrotizing fasciitis / myonecrosis) with fever (38oC), chills and brownish malodorous drainage,because of infected extended ulcer (PEDIS 4) of left ankle. He reported use of hydrocolloid dressingsfor the previous week. After admission, he was treated with extended surgical debridement and ivantibiotics (pip/tazo, metronidazole, clindamycin). Alginate wound dressings with daily change wereused. Culture grew Citrobacter freundii and Streptococcus uberis (streptococcus pyogenes). Patient’soutcome was satisfactory.

Case 2: A 80-year-old man with T2DM (on insulin) and PAD (70-75% stenosis) presented with PEDIS 3infection (left 1st toe extending to mid-metatarsal) following trauma that occurred 2 months before. Hereported recent antibiotic therapy (cefuroxime/clindamycin). He had no systemic symptoms, but therewas severe local pain. After admission, patient was treated with iv ampicillin/sulbactam. On day 2clindamycin was added because of localized necrotic areas. Apart from arterial calcification, X-ray wasotherwise normal. Surgical incision and debridement of lateral side of toe was performed and patient’scondition improved. Toe nail came out spontaneously after 2 weeks. Patient’s outcome was satisfactory.

Conclusion: Diabetic patients with PAD deserve increased level of suspicion for NSTIs, which consista medical emergency. Immediate treatment with surgical debridement and antibiotic regimen includingclindamycin is imperative.

36


USE OF VACUUM-ASSISTED CLOSURE (VAC) DEVICE IN A DIABETIC FOOT CLINIC

C. Loupa, E. Meimeti, A. Donou, E. Voyatzoglou, I. Bakas, D. Voyatzoglou†


Introduction: Negative pressure wound therapy, otherwise vacuum-assisted closure (VAC), is arelatively new (mid-‘90s) adjunctive therapy for open wounds that applies subatmospheric pressure tothe wound surface. VAC has been utilized in the treatment of wounds from acute injury (eg, trauma,burns, surgical debridement), and diabetic foot ulcers. It has several advantages over traditional woundmanagement, including simplification of wound care and accelerated wound healing, with subsequentshortening of patient hospitalization.

Purpose: To record all diabetic patients with foot ulcers treated with VAC in our foot clinic. We studiedpatient outcome but also cost effectiveness of VAC.

Patients - Methods: Retrospective study including 13 diabetic patients with diabetic foot ulcers treatedwith VAC as adjunctive therapy. These patients, 8 men / 5 women, age 44-76 years, presented atdiabetic foot clinic of A. Fleming General Hospital fron January to December 2009.

Results: There was successful outcome (complete healing) in all 13 patients with diabetic foot ulcers,and they are still seen in our diabetic foot clinic. Unfortunately, 3/13 patients presented again withulcerations occurring in the same or different location, because of inappropriate footwear and poorglycemic control.

Conclusion: VAC has successfully been utilized in the management of diabetic foot ulcers. Its usereduces edema, increases blood flow, stimulates granulation tissue and accelerates wound healing,thus decreasing hospital stay. But considering its increased costs {hospital price 450 EUR for eachapplication (foam dressing, semiocclusive adhesive cover, fluid collection system) and usually 2-3applications per patient are needed}, VAC has to be applied only in selected cases of diabetic footulcers, when conventional treatment has failed: in deep, complicated and nonhealing ulcers, in youngerpatients with satisfactory performance status and, most important, with good compliance regardingglycemic control, offloading and appropriate footwear.

37


SUCCESFUL TREATMENT OF SELECTED CASES OF OSTEOMYELITIS IN THE DIABETICFOOT WITHOUT SURGICAL BONE REMOVAL

C. Loupa1, Ι. Kotsantis1, Ε. Papadakis2, Ε. Voyatzoglou1, Μ. Skopeliti1, Α. Donou1, Κ. Papagiannis2,Ε. Koutsantoniou2, S. Lafoyanni2

1 Demetrios Voyatzoglou Diabetic Foot Clinic2 X-Ray Dept, A. Fleming General Hospital, Athens, Greece

Introduction - purpose: Early diagnosis and culture-based or empirical antibiotic therapy forosteomyelitis (OM) of the diabetic foot (DF) is needed. Traditionally, surgical therapy (bone resection,or even amputation) is considered essential for treatment of chronic OM. Recently, some authoritieshave disputed the routine need for surgical therapy. We describe 2 cases of successful treatment ofDF OM without surgical bone removal. Diagnosis was based on clinical grounds and imagingtechniques. Patients were successfully treated with antibiotics, alginate dressings (daily change),LMWH, buflomedil, offloading and tight glucose control. Treatment success was based on clinicalexamination, blood tests and radiology.

Case 1: A 36-year-old man with T1DM with history of foot ulcer 2 years before, peripheral neuropathy(PN) and HbA1c=11,8% presented with multiple infected ulcers (PEDIS 3) of plantar surface of the rightfoot and swollen inguinal lymph nodes, because of inappropriate footwear during summer holidays. X-ray showed osteolysis of 1st metatarsal, and MRI showed extended inflammation with osteomyelitis.Culture grew MSSA, Enterococcus, CNS, Corynebacterium, Bacteroides, Prevotella, & anaerobicpeptococcus. Targeted antibiotic therapy was given for a total of 3.5 months (iv for the first 5 weeks).Patient’s condition remains satisfactory at 6 months’ follow-up.

Case 2: A 72-year-old woman with T2DM on insulin with history of toe amputation 2 years before, PN,peripheral angiopathy and HbA1c=9% presented with worsening of pre-existing (for 4 months) ulcer of2nd toe (‘sausage toe’). X-ray showed 1st metatarsal absorbtion. Culture was unreliable, and empiricalantibiotics were given for 6 months (iv for the first 2 weeks). Although x-ray at 4 weeks showedworsening, radiology at 15 weeks showed significant improvement. She was in good shape at 2 months’follow-up.

Conclusion: Medical therapy of DF OM, without surgical bone removal, needs persistent and long-termtreatment, but it can be successful in selected cases, despite the contrary beliefs of some doctors,especially surgeons. Consequently, surgical treatment and especially amputation is not necessary inmany cases.

38


REPRODUCIBILITY OF THE LANARKSHIRE OXIMETRY (LOI) INDEX IN TYPE 2 DIABETESMELLITUS

Papanas N., Kakagia D., Tiaka E., Alexandridou M., Pagkalos A., Kyrgiannaki V., Maltezos E.

Outpatient Clinic of the Diabetic Foot, Second Department of Internal Medicine, Democritus University of Thrace, Greece

Introduction: Lanarkshire Oximetry Index (LOI) is an alternative diagnostic tool for peripheral arterialdisease (PAD).

Purpose: The aim of the present study was to evaluate the reproducibility of LOI in patients with type2 diabetes mellitus (T2DM).

Methods: This study included 10 patients with T2DM (5 men, 5 women, aged 53-77 years). LOI wasmeasured by a pulse oximeter (Nellcor Puritan Bennett, NPB-295, Nellcor Inc) and asphygmomanometer. For finger pressure, the pulse oximeter sensor was placed on the index fingerand the sphygmomanometer cuff around the patient’s upper arm. For hallux pressure, the pulseoximeter sensor was placed on the hallux and the sphygmomanometer cuff around the patient’s calf.Measurements were performed on the right. LOI was calculated by dividing hallux pressure by fingerpressure. To assess intra-observer reproducibility, patients were repeatedly examined by the sameoperator. Inter-observer reproducibility was assessed through examination by a second operator.

Results: Intra-observer variability was low, as evidenced by the % Coefficient of Variance (mean CV%:2.89%, range: 1.66-4.58%). On examination by the two operators, mean difference in LOI was 0.043(range 0.03-0.06).

Conclusion: These results suggest that LOI has excellent reproducibility in T2DM and encourage itsfurther exploration as an alternative diagnostic tool for PAD.

39


IS TISSUE OXYGENATION A MAJOR DETERMINANT OF ULCER OUTCOME IN DIABETICPATIENTS?

C. Manes, Th. Mesimeris, Th. Melekos, St. Stefanidou, E. Pertsas G. Tzatzagou, D. Mpaltzis, B. Kourkoumpas

Diabetes Center Papageorgiou Gen.Hospital and Hyperbaric Oxygen Therapy Unit. "SAINT PAUL" Hospital,Thessaloniki, Greece

Background: Tissue hypoxia is an important factor in the occurrence of diseases of the lowerextremities in diabetic patients. Therefore, the oxygen at high pressure (increased O2 diffusion in thetissues) has been proposed as an adjunct therapy to address these problems.

Aim: The purpose of this study were a) to assess the therapeutic effects of hyperbaric oxygen therapycombined with conventional therapeutic approaches to lesions in the "diabetic foot" and b) the searchfor factors that might predict the outcome.

Patients - Methods: The study included 23 diabetic 9,74 and duration±patients (type-approval2 n=19,males n=16), aged 58,87 8,5 years. ±of disease 13 The clinical examination included assessment ofthe severity of a) ulcer (classification by Wagner) b) of diabetic neuropathy (nerve dysfunction indexdetermination - NDS and vibration perception threshold - VPT) and c) peripheral vascular disease(clinically and by determining the ABI Tissue oxygenation. was assessed by transcutaneous PO2 innormal conditions (1 ATA) and hyperoxia (O2 breathing at 2.4 ATA).

Results: a) Ulcers (by Wagner) degree (4) n = 4, (3) n = 6, (2) n = 10, (1) n = 3, b) neuropathic ulcersn=8, neuroischemic n=12, ischemic n=3. Healing of ulcers was achieved in 14 (61%) - group A,improvement in 5 (21%) - Group B and failure in 4 (18%) - group C. There were no differences betweengroup A and group B regarding age, disease duration, blood glucose, NDS, VPT, PO2 (normal conditions65±40 mmHg vs 69±26 p=ns) and PO2 in hyperoxia (465±275 mm Hg vs 402±135 mm Hg, p=ns).Comparing groups A and C was found higher PO2 in hyperoxia in group A (465± 275 mm Hg vs 203±106 mm Hg p <0,05), while other factors did not show any differences.

Conclusion: The administration of hyperbaric oxygen is a useful therapeutic approach (complementary)in diabetic foot disease. Patients with reduced tissue oxygenation in hyperoxia did not respond totherapeutic approach.

Index

42

AAlexandridou M. OP19

Alexiadou K. OP8

Arapostathi C. OP4

Argiana V. OP3, OP4, OP6, OP8,OP9

Argitis V. OP5

BBakas I. OP16, OP17

Balla I. OP3, OP4, OP9

Bristianou M. OP2

CChatzidakis I. OP2

Chorepsima S. OP3

Chryssis D. OP16

DDervisis K. OP5

Donou A. OP7, OP16, OP17,OP18

EEleftheriadou I. OP3, OP4, OP6, OP8,

OP9

Exiara T. OP10, OP11

FFardi P. OP8

Fatourou M. OP16

GGeorga S OP1

Georgiadis G. OP13

Giandikidis S. OP1, OP13

Grigoropoulou P. OP3, OP4, OP6, OP8,OP9

Grivou K. OP12, OP14, OP15

KKakagia D. OP19

Kalopita S. OP8

Karagiannidou D. OP12

Katsilambros N. OP3, OP4, OP6, OP8,OP9

Kefalogiannis N. OP10, OP11

Kirlaki E. OP10, OP11

Kokkinos A. OP3, OP4, OP6, OP8,OP9

Kotsantis I. OP18

Kourkoumpas B. OP20

Koutsantoniou E. OP18

Kritikos C. OP4

Kyrgiannaki V. OP19

Kyriakidis K. OP5

LLafoyanni S. OP18

Lanaras L. OP2

Lazaridis M. OP1, OP13

Loupa C. OP7, OP16, OP17,OP18

MMaltezos E. OP10, OP11, OP19

Manes C. OP1, OP10, OP11,OP13, OP20

Marathonitis G. OP16

Matis A. OP12, OP14

Meimeti E. OP7, OP17

Melekos T. OP20

Mesimeris T. OP1, OP20

Mikropoulos D. OP14, OP15

Mousleh Z. OP1, OP13

Mpaltzis D. OP20

Mytis G. OP2

43

PPagkalos A. OP19

Panou C. OP2

Papadakis E. OP18

Papagiannis K. OP18

Papanas N. OP1, OP10, OP11,OP13, OP19

Papantoniou S. OP10, OP11

Papathoma S. OP12, OP14, OP15

Papazoglou N. OP1, OP13

Pavlidou D. OP12

Perrea D. OP3, OP4, OP6, OP8,OP9

Pertsas E. OP20

Petridis G. OP12, OP14, OP15

Psarra A. OP15

SSbardos A. OP14

Sidiropoulou S. OP12, OP14, OP15

Siomos K. OP13

Skopeliti M. OP16, OP18

Skoutas D. OP1, OP13

Souftas V. OP13

Souliotis N. OP7

Stefanidou S. OP20

TTabakis H. OP5

Tentolouris N. OP3, OP4, OP6, OP8,OP9

Tiaka E. OP19

Tsachouridis A. OP12, OP14, OP15

Tsachouridou O. OP12, OP14, OP15

Tsetselidou M. OP14

Tsiantas G. OP1

Tsiligrou V. OP2

Tsotoulidis S. OP10, OP11, OP12,OP14, OP15

Tzatzagou G. OP20

Tzovanaki M. OP15

VVoyatzoglou E. OP7, OP16, OP17,

OP18

Voyatzoglou† D. OP7, OP16, OP17

ZZoupas C. OP6, OP9

44

General Information

Conference Date

July, 7-10, 2011

Conference Venue

AKS PORTO HELI HOTEL****

Conference Center

Porto Heli, 21061, Argolis, Peloponnese

Tel.: +30 27540 - 98073

Fax: +30 27540 - 53 410

Website: www.akshotels.com/porto-heli-hotel.html

Official Language

The official languages of the Conference are Greek and English. Simultaneous translation will

be provided.

Certificate of Attendance

All registered participants will receive a Certificate of Attendance with fifteen (15) CME Credits,

from the Secretariat desk, at the closing session of the Conference.

Name Badges

Each participant will receive a name badge upon registration. For their convenience,

participants are requested to wear their badge at all times during the Conference.

Exhibition Hall

The commercial exhibition will be held at the Porto Heli Conference Center of the AKS Hotel.

Access to the exhibition is free for registered participants. The exhibition will be open on 7 - 9

July 2011, during Conference hours.

Registration Fees

(a 23% VAT will be added to the above mentioned prices)

Registration fees cover:

• Access to the scientific sessions/workshops and exhibition

• Meeting material (bag, book of abstracts, certificate of attendance)

Up to 31st May 2011 200€

June 1st, 2011 - On site 250€

45

AcknowledgementsThe Organizing Committee of the 1st Annual Joint Conference of EMEDIP & MEET wish to

thank the following sponsors for their kind contribution to the success of the Conference.

S LIFE LTD

Roche (Hellas) S.A.

Contact Information

Conference Secretariat

12 Thessalonikis StreetGR 15344 Gerakas, Attiki, Greece

Tel.: +30 210 6048260Fax: +30 210 6047457

E-mail: [email protected]@free-spirit.gr

Web site: www.free-spirit.gr

free spιrιtG e t t i n g y o u t h e r e !

HELLENIC ASSOCIATION FOR THE STUDY OF THE DIABETIC FOOT

104 Pontou Street, GR 115 27 Athens, GreeceΤel.: +30 210 7470089Fax: +30 210 7470044

E-mail: [email protected] Web site: www.emedip.gr

Documents

Invitation - Free Spirit · 2011. 7. 1. · Invitation Dear Colleagues, It is with great pleasure that we invite you to join us to the 1st Annual Joint Conference of the Hellenic